FOI 2026/1813

• Nominate an AMS Champion.

• Participate in World AMR Awareness Week (WAAW).

• Submit a Quality Improvement (QI) plan with outcomes.

Requirement 2 (Reduction in total antibiotic prescribing):

• Reduction in overall antibiotic items per STAR-PU to ≤0.871.

The 12-month rolling figure on March 31st, 2027, will be compared to the baseline figure on March 31st, 2026, to calculate achievement.

Requirement 3 (Reduction in broad spectrum antibiotic prescribing and increased coding):   • The 12-month rolling figure on March 31st, 2027, for the proportion of antibiotics prescribed from broad spectrums (cephalosporins, co amoxiclav and quinolones) to be ≤10% AND

• ≥70% of broad-spectrum antibiotic prescriptions issued between April 1st 2026 and March 31st 2027 must have a coded indication.

Requirement 4 (Antibiotic prescribing in Children 0-9 Years):

• Percentage of registered children aged 0–9 years prescribed ≥1 antibiotic in last 12 months ≤ 25% (national target) by March 31st, 2027,

Core Requirements for GP Practices

Practices delivering this service must:

• Review and respond to new shared care of medicines requests within 14 days of receiving the request to confirm acceptance or refusal of shared care.

• Code all decisions (accepted, declined, or “accepted with concerns” *) using agreed SNOMED codes (see SNOMED code section) for new and historical shared care prescribing. • Maintain an up-to-date register of shared care patients.

• Ensure prescribing and monitoring are undertaken as per the relevant SCP requirements.

1. Every patient using a DOAC should have at least annual monitoring (some individual patients will require more) which should include up to date: • Full blood count • Liver function tests • Urea and electrolytes • Serum creatinine (for creatinine clearance) • Weight (for creatinine clearance)

2. Contemporaneous Creatinine Clearance levels should be calculated using the MDCalc Creatinine Clearance (Cockcroft-Gault Equation) and input into the patient notes within a maximum of 3 months following their creatinine results.

3. Once the CrCl score has been entered into the patient records by practice staff, the DOAC choice should be reviewed to ensure continued appropriateness against the CrCl score for each patient.

4. Use GMMMG document to guide changes based on CrCl levels DOAC-review of-NVAF-patients_FINAL_FOR_WEB-v1.0_SEPTEMBER-2024.pdf

5. All patients who are identified to not be on an optimal DOAC or dose following their CrCl calculation or due to a change in weight, should have their DOAC reviewed to ensure safe prescribing and be invited for a DOAC review – this is in line with safe prescribing guidance and in many practices often takes place via an annual review.

6. This annual DOAC review should be recorded on clinical system by using recording each of the elements • Full blood count • Liver function tests • Urea and electrolytes • Serum creatinine (for creatinine clearance) • Weight (for creatinine clearance) • Creatinine Clearance

7. In addition, where patients are not prescribed apixaban or rivaroxaban as their DOAC (so are prescribed Dabigatran or Edoxaban), these patients should be consulted about switching to apixaban or rivaroxaban. This can take place during their annual review or via a separate interaction to discuss a switch in medication. This discussion should be recorded in the clinical system using the following codes: • Treatment changed SNOMED CT: 445528004 • If patient declined the switch use: Drug declined by patient – alternative therapy SNOMED CT: 182901005 • If the review leads to a dose change: SNOMED CT: 1364161000000108 – Direct-acting oral anticoagulant dose changed (situation) • If the review is complete but nothing was changed, then: 1364181000000104 – Direct-acting oral anticoagulant dose not changed (situation)

8. The guidelines for DAOC switched are included here. Patients newly commencing on a DOAC should also be initiated on DOACs in line with these guidelines. DOAC-review-of-NVAF-patients_FINAL_FOR_WEB v1.0_SEPTEMBER-2024.pdf and GM’s commissioning statement.

Practices are required to:

• Review prescribing of Low Priority Products in line with NHS England » Items which should not routinely be prescribed in primary care: policy guidance and PrescQipp Low priority prescribing

• Use provided searches to identify patients prescribed LPP medicines.

• Undertake reviews, including shared decision-making discussions with patients where changes or deprescribing are indicated.

• Implement agreed actions to reduce, stop or switch LPP medicines to clinically appropriate alternatives where suitable

Practices will be expected to invite all patients from the GM SaferPrescribingNeed (SPN) Dashboard with “very high” and “high” unmet SaferPrescribingNeed scores and prioritise these cohorts for structured medicines reviews.

Practices will be expected to collaborate at a PCN level with other practices, wider primary care, community teams, voluntary sector partners and others to develop quality improvement plans* focusing on either a) or b) below.

The aim of the QI plan is to take a proactive approach through implementing coordinated population‑level interventions that prevent patients moving into higher unmet need cohorts and support sustainable reductions in harm across the PCN:

a. Polypharmacy and Anticholinergic Burden

b. Opioids and Dependence Forming Medication

100% of “very high” and “high” unmet population cohort to be invited to a Structured Medication Review

SMR completion for “very high” and “high” unmet need population cohort

Submission of PCN QI Plan – Quarter 1

Submission of QI Evaluation, Outcomes, Reflections and Supporting Evidence – Q4

Reductions in very high and high unmet need population cohorts

1. Use of consistent clinical coding Practices should: – Retrospectively review patient records and ensure that relevant clinical coding associated with tirzepatide prescribing is accurate and complete (using practice-initiated searches) – Prospectively ensure that relevant clinical codes associated with tirzepatide prescribing are recorded appropriately by practice clinicians.

2.. Clinical audit Practices are asked to carry out a clinical audit in Quarter 2 2026/27 (July-September 2026). Searches will be provided for practices to support this. The aim of the clinical audit is to: • Identify any gaps in clinical coding and to address these through a clinical review of records and addition of appropriate codes (as outlined above) and • To identify any gaps in clinical care in relation to tirzepatide prescribing with appropriate clinical actions to address these

Payment will be based on coded shared care.